The aggressive phenotype revisited: Utilization of higher-risk liver allografts

J. M. Garonzik-Wang, N. T. James, K. J.Van Arendonk, N. Gupta, B. J. Orandi, E. C. Hall, A. B. Massie, R. A. Montgomery, N. N. Dagher, A. L. Singer, A. M. Cameron, D. L. Segev

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Organ shortage has led to increased utilization of higher risk liver allografts. In kidneys, aggressive center-level use of one type of higher risk graft clustered with aggressive use of other types. In this study, we explored center-level behavior in liver utilization. We aggregated national liver transplant recipient data between 2005 and 2009 to the center-level, assigning each center an aggressiveness score based on relative utilization of higher risk livers. Aggressive centers had significantly more patients reaching high MELDs (RR 2.19, 2.33 and 2.28 for number of patients reaching MELD > 20, MELD > 25 and MELD > 30, p < 0.001), a higher organ shortage ratio (RR 1.51, 1.60 and 1.51 for number of patients reaching MELD > 20, MELD > 25 and MELD > 30 divided by number of organs recovered at the OPO, p < 0.04), and were clustered within various geographic regions, particularly regions 2, 3 and 9. Median MELD at transplant was similar between aggressive and nonaggressive centers, but average annual transplant volume was significantly higher at aggressive centers (RR 2.27, 95% CI 1.47-3.51, p < 0.001). In cluster analysis, there were no obvious phenotypic patterns among centers with intermediate levels of aggressiveness. In conclusion, highwaitlist disease severity, geographic differences in organ availability, and transplant volume are the main factors associated with the aggressive utilization of higher risk livers.

Original languageEnglish (US)
Pages (from-to)936-942
Number of pages7
JournalAmerican Journal of Transplantation
Issue number4
StatePublished - Apr 2013


  • Extended criteria donors
  • graft acceptance
  • liver transplantation
  • transplant centers

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


Dive into the research topics of 'The aggressive phenotype revisited: Utilization of higher-risk liver allografts'. Together they form a unique fingerprint.

Cite this